Hyperlipidaemia

Question 1

Lipid modification

Answer 1

• Reduction of CVD which is caused by blood clots

Question 2

Atherosclerosis

Answer 2

• Build up of fatty deposits in artery causing it to narrow restrict flow and harden not elastic

Question 3

Cardiovascular conditions caused by atherosclerosis

Answer 3

• CHD
• Stroke
• Transient ischaemic attack
• Peripheral arterial disease

Question 4

Primary prevention Cardiovascular events

Answer 4

• Alter modifiable risks and reduce incidence in disease free individual
• CVD risk review ongoing over 40
• Q risk analysis

Question 5

Secondary prevention

Answer 5

• Use strategies to target individuals that have an event use statin

Question 6

Healthy level cholesterol

Answer 6

5mmol/L or below
Total HDL less then 6

Question 7

Formal risk assessment

Answer 7

• QRISK 3 for patient aged 25-84 with type 2 diabetes
• Do not do risk assessment for high risk CVD and type 1 diabetes
• May underestimate risk if previous HIV or recent smoke quit

Question 8

When do you use 3-lifetime assessment

Answer 8

• Cardiovascular risk under 10% or under 40 with CVD

Question 9

Pharmacological treatment

Answer 9

• Discuss with patients the risks and benefits
• Aim of treatment is to achieve a greater than 40%
  reduction in non-HDL-C levels

Question 10

Baseline Tests

Answer 10

• Non-fasting lipid profile
• Liver function test
• Renal function and GFR rate
• Creatine kinase - due to muscle pain
• Thyroid test

Question 11

Starting recommendation for satins

Answer 11

• 20mg of Atorvastatin
• if ages 84 and younger with 10% QRISK
• Give anyway if having type 1 diabetes
• Chronic kidney disease no requirement for QRISK

Question 12

Secondary prevention pharmacological treatment

Answer 12

• 80mg Atorvastatin give for those who had a heart attack, angina and stroke.

Question 13

Family Hyperlipidemia

Answer 13

• Inherit high cholesterol present from birth developing CVD

Question 14

Clinical signs and hypercholesterolemia

Answer 14

• Tendon xanthoma (ankle bulge)
• Xanthelasmas eye lids skin flaky
• Corneal arcus - white ring around eye

Question 15

Children Familial hyperlipidaemia

Answer 15

• Usually start at lower dose from age of 10

Question 16

Atorvastatin side effects

Answer 16

• Muscle effects and toxicity
• GI disturbances
• Sleep disorders
• Nose bleed

Question 17

When can statins be taken

Answer 17

• Atorvastatin and rosuvastatin taken any time other statins at night

Question 18

Function of statins

Answer 18

• Blocks enzymes involved in cholesterol synthesis

Question 19

What do you monitor for statins

Answer 19

• Liver function and lipids
• Ask patients to report severe muscle pain
• Use contraception while on drug

Question 20

Other medication instead of statins

Answer 20

• Consider ezetimibe, co-administered with atorvastatin for people
  with primary hypercholesterolaemia

Question 21

Ezetimibe function

Answer 21

• 10mg inhibits the intestinal absorption of
  cholesterol

Question 22

Side effects of Ezetimibe

Answer 22

• GI disturbances
• asthenia
• muscle pain - uncommon

Question 23

Ezetimibe with bempedoic acid

Answer 23

• If it doesn’t control levels alone use the bempedoic acid

Question 24

Bempedoic acid function

Answer 24

• Inhibits cholesterol synthesis in the liver,
  thereby lowering LDL-cholesterol

Question 25

Side effects of Bempedoic acid

Answer 25

- anaemia - gout - hyperuricaemia - GI disturbances

Question 26

Counselling for Bempedoic acid

Answer 26

Avoid pregnancy and breastfeeding

Question 27

Fibrates

Answer 27

- Not routinely given to people as primary or secondary prevention - Sometimes used for Family history

Question 28

Colestyramine

Answer 28

- Not routinely given to people as primary or secondary prevention - Sometimes used for Family history

Question 29

Inclisiran

Answer 29

- Patient that are high risk due to previous CV events - Patients with recurrent polyvascular disease - Patients with HeFH

Question 30

Function of Inclisiran

Answer 30

- limits production of PCSK9, increasing uptake of LDL-cholesterol and thereby lowering levels in blood

Question 31

Counselling for inclisiran

Answer 31

- Should not be used outside * If a dose is more than 3 months late, treatment should be re-initiated.